Halt NSAIDs use before gum surgery, Case researchers say

July 19, 2005

Researchers from the Case Western Reserve University School of Dental Medicine recommend the discontinuation of ibuprofen prior to surgery to correct gum disease because blood loss is two times greater for those using the medication than those not taking it.

In the study, the Case researchers found that ibuprofen, a popular and widely used over-the-counter medication taken to relieve inflammation in arthritis and prevents blood clots associated with heart disease, can result in increased bleeding during surgery.

While previous studies have shown increased bleeding during other types of surgeries, Case researchers published their finding on one of the first studies to examine the use prior to oral surgery and its effects on rates of bleeding during and after periodontal surgery for gum disease. The findings were reported in the article, "The Effect of NSAIDs on Bleeding during Periodontal Surgery" in the July issue of the Journal of Periodontology, the official publication of the American Academy of Periodontology.

"Taken prior to periodontal surgery, ibuprofen increases blood loss during surgery in patients up to almost two times that of those who did not take ibuprofen," report the researchers.

In the single-blind, case-controlled study at the Case dental school, 15 individuals underwent two surgeries. They were asked to take one 400 mg ibuprofen tablet at time intervals of nine, five and one hours prior to one of two surgeries to maximize the drug's activity during the surgical procedure. Patients did not inform the periodontist performing the surgery about the drug use. In a pre-operative test before the use of ibuprofen, each patient underwent a bleeding time test to determine their normal rate of blood loss.

During and following surgery, the amount of blood loss was measured for 30 second intervals. Each surgery was timed to the exact procedure, and time of the other surgery to prevent skewed results that impact blood loss rates.

"The intervals at 30 through 75 minutes showed a statistically significant increase in blood loss with ibuprofen intake," report the researchers.

Blood loss also showed a significant increase with ibuprofen use for those undergoing bone surgery procedures.

The researchers found that the difference between patients using ibuprofen and the non users was an increase of approximately 15 ml of blood or approximately double the amount of blood loss without NSAID's use.

In reporting pain during the surgery, eight of the ibuprofen users reported less pain while the other seven patients reported the similar or increased pain, said the researchers.
The study's lead researcher was Annabel Braganza, who conducted the research while a resident in periodontolgy at the Case School of Dental Medicine and who is now in private practice in Ontario, Canada, with Case periodontists Nabil Bissada (chair of periodontolgy) and Anthony Ficara and Craig Hatch from oral medicine department at the Cleveland Clinic Foundation.

For further information about the study, contact Dr. Bissada at 216-368-6757 or nabil.bissada@case.edu.

Case Western Reserve University

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